Vocal Cord Issues in Corpus Christi, TX
The vocal cords also called vocal folds are two paired bands of mucosa-covered muscle and connective tissue within the larynx that vibrate against one another to produce voice. Precise, coordinated movement of these structures is essential not only for phonation but for airway protection during swallowing, coughing, and Valsalva maneuvers. Disorders of the vocal cords are among the most common reasons patients are referred to an ENT specialist, and they range from benign, self-limiting conditions to serious pathology requiring urgent evaluation. At Corpus Christi ENT Sinus & Allergy, Dr. Todd M. Weiss provides comprehensive evaluation and management of the full spectrum of vocal cord disorders using in-office fiberoptic laryngoscopy.
Common Vocal Cord Disorders
Vocal Cord Nodules
Vocal cord nodules are bilateral, symmetrically positioned callus-like lesions at the junction of the anterior and middle thirds of the vocal cords the point of maximum vibratory impact. They are caused by phonotrauma: repetitive, forceful vocal cord collision from vocal overuse, misuse, or abuse. Vocal cord nodules are the most common cause of dysphonia in children and are prevalent in professional voice users including singers, teachers, coaches, and call center workers. They produce a breathy, rough voice quality and vocal fatigue. Treatment is primarily behavioral voice therapy with a speech-language pathologist addresses the underlying vocal hygiene and technique deficits that produced the nodules. Surgical excision is reserved for nodules that fail to respond to adequate voice therapy.
Laryngopharyngeal Reflux and Vocal Cord Irritation
Laryngopharyngeal reflux (LPR) the backflow of gastric contents to the laryngopharynx is one of the most common laryngeal diagnoses. It causes erythema and edema of the posterior larynx and arytenoids, vocal cord granulomas, subglottic stenosis (in chronic cases), and symptoms including chronic throat clearing, globus sensation, hoarseness, chronic cough, and a sensation of postnasal drip. Diagnosis is clinical, supported by laryngoscopic findings. Treatment involves dietary and lifestyle modifications combined with proton pump inhibitor therapy; behavioral modifications including cessation of late-night eating and head-of-bed elevation are essential.
Vocal Cord Polyps
Vocal cord polyps are unilateral, soft, fluid-filled or fibrous lesions arising from the free edge or superior surface of one vocal cord. Unlike nodules, they are typically caused by a single traumatic vocal event shouting at a sporting event, for example or by chronic laryngeal irritation from smoking or reflux. Polyps produce a markedly hoarse, breathy, or rough voice quality that rarely improves with voice therapy alone. Surgical excision under microlaryngoscopy is the treatment of choice, followed by a post-operative course of voice therapy to optimize healing and prevent recurrence.
Vocal Cord Cysts
Vocal cord cysts are fluid-filled sacs beneath the mucosal surface of the vocal cord, classified as mucus retention cysts or epidermoid (inclusion) cysts. They may present as a unilateral vocal cord mass causing hoarseness and may be indistinguishable from a polyp on routine laryngoscopy; videostroboscopy and microlaryngoscopic examination are required for definitive characterization. Treatment is surgical the cyst is carefully dissected from the surrounding mucosa under microlaryngoscopy to preserve the underlying vocal ligament.
Vocal Cord Granulomas
Contact granulomas are inflammatory lesions arising from the vocal process of the arytenoid cartilage the posterior attachment point of the vocal cords. They are most commonly caused by laryngopharyngeal reflux (acid-pepsin injury to the posterior larynx), vocal cord trauma from intubation, or phonotrauma (forceful glottal attack during speaking). They cause throat pain, globus sensation, and dysphonia. Treatment addresses the underlying cause primarily aggressive anti-reflux management often combined with voice therapy. Surgical removal is occasionally necessary for refractory lesions but is complicated by high recurrence rates without concurrent anti-reflux therapy.
Spasmodic Dysphonia
Spasmodic dysphonia is a focal laryngeal dystonia an involuntary muscle contraction disorder in which the laryngeal muscles spasm during phonation, producing a strained, strangled (adductor type) or breathy, effortful (abductor type) voice quality. It is a neurologic condition distinct from structural vocal cord lesions. The most effective treatment is periodic botulinum toxin (Botox) injection into the affected laryngeal muscles, administered under electromyographic or laryngoscopic guidance. Injections are repeated every three to six months as symptoms return.
Muscle Tension Dysphonia
Muscle tension dysphonia (MTD) is a functional voice disorder caused by hypercontraction of the extrinsic and intrinsic laryngeal muscles during phonation, resulting in a strained, effortful, or fatigued voice. It may occur in isolation (primary MTD) or as a compensatory response to an underlying structural lesion (secondary MTD). Treatment is voice therapy with a certified speech-language pathologist, which is highly effective when compliance is maintained.
Vocal Cord Cancer
Squamous cell carcinoma of the larynx most commonly arises on the true vocal cords (glottic carcinoma). Hoarseness is the earliest and most reliable presenting symptom of glottic cancer because even very small tumors on the vocal cord surface impair vibration and produce dysphonia. Any hoarseness lasting more than two to three weeks in a patient with a history of tobacco or alcohol use requires prompt laryngoscopic evaluation. Early-stage glottic carcinoma has an excellent prognosis, with cure rates exceeding 90 percent for stage I disease treated with radiation therapy or transoral laser microsurgery.
Vocal Cord Paralysis and Paresis
Vocal cord paralysis occurs when one or both vocal cords are unable to move due to disruption of the recurrent laryngeal nerve or superior laryngeal nerve the nerves supplying the intrinsic laryngeal muscles. Causes include thyroid surgery, anterior cervical spine surgery, chest surgery, neck dissection, thyroid or lung cancer, viral neuritis, and idiopathic causes. Unilateral vocal cord paralysis produces a weak, breathy voice and may cause aspiration of liquids. Bilateral vocal cord paralysis impairs the airway and may produce stridor and respiratory distress.
Treatment for unilateral vocal cord paralysis includes a period of observation (as spontaneous recovery can occur within 12 months), voice therapy, and, when intervention is required, vocal cord medialization either by injection laryngoplasty (in-office or operating room injection of a bulking agent into the paralyzed cord to medialize it) or open medialization thyroplasty (permanent implant-based medialization).
When to Seek Evaluation
- Hoarseness or voice change lasting more than two to three weeks
- Sudden or progressive loss of voice
- Pain with speaking or swallowing
- A sensation of something in the throat (globus)
- Stridor (a high-pitched breathing noise) warrants urgent evaluation
- Voice change following neck, thyroid, or chest surgery
- Chronic hoarseness in a current or former smoker do not delay evaluation
Schedule an Appointment Today
If you’ve had a hoarse voice or other voice changes lasting more than two to three weeks, an evaluation is important. Call us at (361) 320-6130 or connect with us online to schedule a laryngoscopic evaluation.